'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

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The PCT accused of hounding a GP to his suicide after pursuing an investigation into his high referral rate has sent a letter to its practices demanding they cut their referrals.

The letter from the chief executive of Charnwood and North West Leicestershire PCT warns it may not 'fulfil its statutory duty' to break even unless GPs reduce referrals.

It adds that unless GPs co-operate, it will be forced to take 'crude and Draconian' action to deal with a £5 million budget shortfall.

Charnwood and North West Leicestershire PCT was criticised by an external inquiry into the suicide of Dr Stephen Farley for failing to recognise the GP's health problems when pursuing a three-year investigation into his referral rate.

GPs in the PCT accused the trust of putting the resolution of its financial problems before quality of patient care.

Dr Dermot Ryan, a GP in Loughborough, said GPs should not be pressurised to change their referral habits.

He said the trust was picking on GPs while failing to recognise the 'churn' of patients in hospitals, who are being discharged and readmitted to a different department to create extra activity.

He said: 'The PCTs are the first people to get on your backs if you fail to refer properly. Over the last three years we've said there should be penalties for non-performance of hospitals.'